For this series of blog reflections on the subject of institutional invention, I would like to move from "imperceptible institutions" towards the definition of institutions as ecologies within which myriads of perceptions intersect and agents act. In this sense (and specifically in relation to healthcare which is my current research focus), the question is whether it is possible to imagine a dynamic, distributed and democratic practice of care and emancipation in the contemporary reinvention of welfare. What is at stake is the need for a new imagination of social rights through the crisis, or, the possibility of a different practice of care in everyday life.
For this to become real, it is essential to encounter concrete practices and alternative imaginations that are providing a gateway of healing, out of the contemporary crisis. Here, I focus on Trieste, where the reinvention of care started almost half a century ago, with Franco Basaglia in the 1970s.1 There, radical politics of welfare have become hegemonic in the mental health services, transforming the real lives of thousands of people. The struggle is still very vivid today: how can we invent institutional critique as a quotidian practice of emancipation?
From the beginning, the prerogative of the Basaglian practice was to destitute the prescriptive approach of technicians of healthcare – as paternalistic and organic intellectuals. This was a critique of the welfare state that reinvented the practice of care around the user. In the last decades, that has been translated from mental healthcare to healthcare in general, moving the provision of services from the hospital to the city, in the urban space, forcing the medical practice (and significantly healthcare professionals) to settle in the lives of users. The aim was to intertwine the practice of health and care with the lives of the citizens and generally of the city. Make care, take care2.
Today, in 15 small deprived areas of Trieste, the Micro Area programme has set up activities of integrated care that link community healthcare practices with social services and civil society networks. In this programme, the production of provision happens on the threshold, as a device that destitutes and institutes the practice of care. A worker told me that "limits do not exist, the service is there, the space is there to be inhabited". The limits of the state are contested in a concrete way, through the production of thresholds of invasion. Instead of individualising the citizen in relation to the state, they constitute a collective ethos based on responsibility, reciprocity, inclusiveness. In these politics of care, the practice intervenes in the open ecology of the city, enters outside and participates in inventing the urban fabric.
This invention cannot be formalised, reduced to the norm, however it cannot just be dismissed as a sort of dreaming intuitive practice. The possibility of constituting a common ground of transparency and richness for the institutional practice, a practice of critique that reinforces and affirms these experimental devices, lies in the production of a catalogue of care. This would be a collection of practices that intervenes and develops in a living world; a repertoire of inventions and instruments that can be problematised and improved. This would allow discussions in an operative way about how to activate resources and services. The catalogue would therefore function as shared knowledge production in-between the user, the public workers, the social ties of a specific neighbourhood, the local networks and the urban flows. A catalogue to democratise the design and implementation of local policies in the city.